Fetal heart rate parameters and perinatal outcomes in fetuses with nuchal cords

Hoh, Jeong Kyu; Sung, Young-Mo; Park, Moon-Il

doi:10.1111/j.1447-0756.2011.01707.x

Cited by 13 publications

(8 citation statements)

References 23 publications

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“…We also observed that neonates whose mothers exhibited NFHT had 28.9% greater risk of having nuchal cord, RR Z 1.289, 95% CI (1.185, 1.402) than neonates whose 15 reported that fetal heart rate variability was lower in fetuses with nuchal cord compared to those without and it continued to decrease with multiple nuchal cords. However, this did not result in any adverse neonatal outcome.…”

Section: Discussionsupporting

confidence: 51%

Nuchal cord at delivery and perinatal outcomes: Single-center retrospective study, with emphasis on fetal acid-base balance

Vasa

Dimitrov

Patel

2018

Pediatrics & Neonatology

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Section: Discussionsupporting

confidence: 51%

Nuchal cord at delivery and perinatal outcomes: Single-center retrospective study, with emphasis on fetal acid-base balance

Vasa

Dimitrov

Patel

2018

Pediatrics & Neonatology

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“…33 A healthy newborn was delivered by Cesarean at 33 and 1/7 weeks' gestation with the presence of a true knot confirmed at delivery. 32 In contrast to single nuchal cords, which occur in between 15.8% and 30% of singleton fetuses at term, and have not been unequivocally associated with significant adverse perinatal outcome, 6,20,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] true knot(s) of the umbilical cord occur in 0.04% to 3% of deliveries, and have been associated with perinatal morbidity in 11% of cases, and a notable 4 to10 fold increase in stillbirth. 28,29,[53][54][55][56][57][58][59][60][61][62] Although (multiple) true knots of the umbilical cord have been infrequently implicated with fetal growth restriction, a causal association remains unproven.…”

Section: True Knot(s) Of the Umbilical Cordmentioning

confidence: 99%

<p>Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of True Knot of the Umbilical Cord</p>

Sherer

Amoabeng

Dryer

et al. 2020

IJWH

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Umbilical cord accidents preceding labor are rare. Single and multiple nuchal cords, and true knot(s) of the umbilical cord, are often incidental findings noted at delivery of nonhypoxic non-acidotic newborns without any evidence of subsequent adverse neonatal outcome. In contrast to single nuchal cords, true knots of the umbilical cord, which occur in between 0.04% and 3% of all deliveries, have been associated with a reported 4 to 10 fold increased risk of stillbirth. First reported with real-time ultrasound, current widespread application of color Doppler, power Doppler and three-dimension sonography, has enabled increasingly more accurate prenatal sonographic diagnoses of true knot(s) of the umbilical cord. Reflecting the inability to visualize the entire umbilical cord at prenatal ultrasound assessment, despite detailed second and third-trimester scanning, many occurrences of incidental true knot of the umbilical cord remain undetected and are noted only at delivery. Although prenatal sonographic diagnostic accuracy is increasing, false positive sonographic diagnosis of true knot of the umbilical cord cannot be ruled out with certainty, and must continue to be considered clinically. Notwithstanding the inability to diagnose all true knots, currently there is a clear absence of clinical management guidelines by governing bodies regarding patients in whom prenatal sonographic diagnosis of true knot(s) of the umbilical cord is / are suspected. As a result, in many prenatal ultrasound units, suspected sonographic findings suggestive of or consistent with true knot of the umbilical cord are often disregarded, not documented, and patients are not uniformly informed of this potentially life-threatening condition, which carries an associated considerable risk of stillbirth. This commentary will address current perspectives of prenatal sonographic diagnostic and management challenges associated with true knot(s) of the umbilical cord in singleton pregnancies.

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“…85 Hoh et al in 2012, in data regarding 150 cases with nuchal cords (300 cases without nuchal cords, 124 cases of single nuchal cord, and 26 with multiple nuchal cords), noted that the birth weight of infants with multiple nuchal cords was significantly lower than that of infants without nuchal cords (3317±24 grams versus 3054±55 grams, P=0.0008). 86 Similarly, we followed a patient with a persistent quadruple nuchal cord throughout the third trimester (Figure 4). 87 Repeat sonographic evaluations at 2-week intervals demonstrated gradual continued decelerating fetal growth.…”

Section: Fetal Growthmentioning

confidence: 99%

<p>Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of Nuchal Cord(s)</p>

Sherer¹,

Ward²,

Bennett³

et al. 2020

IJWH

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Umbilical cord accidents preceding labor are uncommon. In contrast, nuchal cords are a very common finding at delivery, with reported incidences of a single nuchal cord of approximately between 20% and 35% of all singleton deliveries at term. Multiple loops occur less frequently, with reported incidence rates inverse to the number of nuchal cords involved. Rare cases of up to 10 loops of nuchal cord have been reported. While true knots of the umbilical cord have been associated with a 4-10-fold increased risk of stillbirth, nuchal cord(s) are most often noted at delivery of non-hypoxic non-acidotic newborns, without any evidence of subsequent adverse neonatal outcome. Prior to ultrasound, nuchal cords were suspected clinically following subtle (spontaneous or evoked) electronic fetal heart rate changes. Prenatal sonographic diagnosis, initially limited to real-time gray-scale ultrasound, currently entails additional sonographic modalities, including color Doppler, power Doppler, and three-dimensional sonography, which have enabled increasingly more accurate prenatal sonographic diagnoses of nuchal cord(s). In contrast to true knots of the umbilical cord (which are often missed at sonography, reflecting the inability to visualize the entire umbilical cord, and hence are often incidental findings at delivery), nuchal cord(s), reflecting their well-defined and sonographically accessible anatomical location (the fetal neck), lend themselves with relative ease to prenatal sonographic diagnosis, with increasingly high sensitivity and specificity rates. While current literature supports that single (and possibly double) nuchal cords are not associated with increased adverse perinatal outcome, emerging literature suggests that cases of ≥3 loops of nuchal cords or in the presence of a coexisting true knot of the umbilicus may be associated with an increased risk of stillbirth or compromised neonatal status at delivery. This commentary will address current perspectives of prenatal sonographic diagnosis and clinical management challenges associated with nuchal cord(s) in singleton pregnancies.

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Fetal heart rate parameters and perinatal outcomes in fetuses with nuchal cords

Abstract: Computerized analysis of FHR would be helpful to assess fetal status, especially in cases of multiple NCs. Multiple NCs may be a subliminal risk factor for the babies even though they present no complications at delivery.

Cited by 13 publications

References 23 publications

Nuchal cord at delivery and perinatal outcomes: Single-center retrospective study, with emphasis on fetal acid-base balance

Nuchal cord at delivery and perinatal outcomes: Single-center retrospective study, with emphasis on fetal acid-base balance

<p>Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of True Knot of the Umbilical Cord</p>

<p>Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of Nuchal Cord(s)</p>

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